• Emanuela Viviani, Claudia De Gregorio, Antonio De Capua, Anna Maria Giribono, Umberto Bracale, Luca Del Guercio, Maurizio Sodo, and Umberto Marcello Bracale.
• Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy.
• Ann Vasc Surg. 2018 Nov 1; 53: 269.e1-269.e9.

BackgroundRuptured mycotic aneurysms are an extremely rare complication of intravesical Bacillus Calmette-Guerin (BCG) immunotherapy. Several cases involving various arterial sites, mostly in the thoracic or abdominal aorta, have been described in the literature. BCG immunotherapy rarely causes false aneurysms and open surgical repair using an in situ prosthetic graft is most commonly performed. Further to this, targeted antituberculous treatment is required for at least one year following surgery.MethodsA 69-year-old man presented at our clinic with fever, lower back pain and malaise. One year before admission he was treated, again, with intravesical BCG for recurrence of a carcinoma.ResultsA large infected pseudoaneurysm of 115mm was treated with the implantation of an aortouniiliac endoprosthesis followed by a crossover femoro-femoral bypass and surgical resection of the mass via an retroperitoneal approach.ConclusionsEndovascular repair can be considered a valid option in an emergency. A hybrid approach was chosen due to the need for urgent action and the poor condition of the patient who was haemodynamically unstable. In particular, the implantation of an aortouniiliac endoprosthesis at the level of the contralateral iliac axis allowed us to avoid the release of an endoprosthesis at the infected area level. Close patient follow-up with clinical evaluation every three months and a CT-scan yearlyis mandatory following the intervention and during antibiotic therapy. A systematic review of the literature has been subsequently carried out on this specific clinical case, highlighting 47 cases described from 1988.Case ReportA large infected pseudoaneurysm of 115 mm presented at our clinic was treated with the implantation of an aortouniiliac endoprosthesis followed by a crossover femoro-femoral bypass and surgical resection of the mass via a retroperitoneal approach.ConclusionsEndovascular repair can be considered a valid option in an emergency. A hybrid approach was chosen due to the need for urgent action and the poor condition of the patient who was hemodynamically unstable. In particular, the implantation of an aortouniiliac endoprosthesis at the level of the contralateral iliac axis allowed us to avoid the release of an endoprosthesis at the infected area level. Close patient follow-up with clinical evaluation every 3 months and a computed tomography scan yearly is mandatory following the intervention and during antibiotic therapy. A systematic review of the literature has been subsequently carried out on this specific clinical case, highlighting 47 cases described from 1988.Copyright © 2018 Elsevier Inc. All rights reserved.

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